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In 2015, the United Nations set important targets to reduce premature
cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately
bears the brunt of CVD burden and has one of the highest risks of dying
from non-communicable diseases (NCDs) worldwide. There is currently
an epide
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miological transition on the continent, where NCDs is projected
to outpace communicable diseases within the current decade. Unchecked
increases in CVD risk factors have contributed to the growing burden of three
major CVDs—hypertension, cardiomyopathies, and atherosclerotic diseasesleading to devastating rates of stroke and heart failure. The highest age
standardized disability-adjusted life years (DALYs) due to hypertensive heart
disease (HHD) were recorded in Africa. The contributory causes of heart failure
are changing—whilst HHD and cardiomyopathies still dominate, ischemic
heart disease is rapidly becoming a significant contributor, whilst rheumatic
heart disease (RHD) has shown a gradual decline. In a continent where health
systems are traditionally geared toward addressing communicable diseases,
several gaps exist to adequately meet the growing demand imposed by CVDs.
Among these, high-quality research to inform interventions, underfunded
health systems with high out-of-pocket costs, limited accessibility and
affordability of essential medicines, CVD preventive services, and skill
shortages. Overall, the African continent progress toward a third reduction
in premature mortality come 2030 is lagging behind. More can be done in
the arena of effective policy implementation for risk factor reduction and
CVD prevention, increasing health financing and focusing on strengthening
primary health care services for prevention and treatment of CVDs, whilst
ensuring availability and affordability of quality medicines. Further, investing
in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on
interventions. This review summarizes the current CVD burden, important
gaps in cardiovascular medicine in Africa, and further highlights priority
areas where efforts could be intensified in the next decade with potential
to improve the current rate of progress toward achieving a 33% reduction
in CVD mortality.
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This publication aims to provide updated guidance on the specific use of yellow fever laboratory assays in the context of surveillance to be used across the Global Yellow Fever Laboratory Network for disease surveillance. In the recent years, new commercial assays became available and are now recomm
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ended for use by WHO and this publication will support national program on the use of compound laboratory assays as per the most recent recommended testing algorithms. This piece is aligned with the elimination effort set in the comprehensive global strategy to eliminate yellow fever epidemics (EYE) strategy 2017-2026 and where its advisory laboratory technical working group actively contributed to its development. The target audiences are policy-makers and health workers.
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When war breaks out in cities, the complexity and interconnectedness of the urban environment poses many problems for civilians. For persons with disabilities, the impact can be even worse and aggravate existing barriers and risks. Armed forces, authorities, first responders, humanitarian actors and
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other persons living in the city itself need to be aware of the specific risks that persons with disabilities face so they can help to reduce them. This factsheet draws attention to some of the biggest risks and makes recommendations on how National Red Cross and Red Crescent Societies could better identify what support persons with disabilities need and incorporate this support into their own operations. It also makes recommendations for how National Societies could promote disability-inclusive interpretations and implementation of international humanitarian law among parties to armed conflict.
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Cholera is an acute gastrointestinal infection caused by the bacterium Vibrio Cholerae serogroup O1 or O139, and is often linked to unsafe drinking water, lack of proper sanitation and personal hygiene. It adversely affects mostly the poor and vulnerable populations in countries, which are already d
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eprived of proper health facilities and conducive environmental conditions. The disease spreads through oro-fecal transmission by the ingestion of contaminated food or water or by person-to-person contact. It has a short incubation period of 2 hours to 5 days and the number of affected cases can rapidly increase across large regions. Cholera is a significant threat to global public health leading to an estimated 3-5 million cases per year worldwide, with an annual toll of 100,000 deaths. The disease was first reported in 1817 from the Ganges Delta of India and since then the ongoing 7th pandemic has emerged from Indonesia, reached Africa in 1970 and Somalia happens to be one of the early affected countries. Over the past few decades,
Somalia has witnessed the occurrence of repeated AWD/Cholera disease outbreaks that have caused high morbidity and mortality across the country.
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The document is a comprehensive practical guide for managing cholera epidemics. It includes detailed instructions on outbreak investigation, control measures, case management, and the organization of treatment facilities. It emphasizes strategies such as rehydration therapy, water sanitation, hygien
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e promotion, and vaccination to prevent the spread of cholera. The guide serves as a resource for healthcare professionals, logisticians, and public health officials to respond effectively to cholera outbreaks.
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A major problem facing the world is how to build peace following the ravages of increasingly protracted armed conflict. Armed conflicts leave behind shattered, divided societies that are at risk of repeating cycles of violence, and therefore need concerted peacebuilding efforts. Conflicts also take
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a heavy toll on people’s mental health and psychosocial well-being. One in five people who live in a war zone will likely develop a mental disorder, and many others suffer from painful everyday stresses associated with multiple losses, family separation, gender-based violence (GBV), disability, climate change and ongoing insecurity, among other issues.
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This document contains guidance for strengthening the disability inclusiveness of MHPSS responses and programmes in emergency settings. It is intended to supplement the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings (2007).
Overall Objective
To consider and add
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ress the mental health and psychosocial support (MHPSS) requirements of persons living in emergency settings with all types of disabilities on an equal basis to the MHPSS requirements of all persons, using a human rights-based approach and implementing social-ecological frameworks.
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Benchmarking is a strategic process often used by businesses and institutes to standardize performance in relation to the best practices of their sector. The World Health Organization (WHO) and partners have developed a tool with a list of benchmarks and corresponding suggested actions that can be a
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pplied to implement the International Health Regulations 2005 (IHR) and strengthen health emergency prevention, preparedness, response and resilience capacities.
The first edition of the benchmarks was published in 2019 to support countries in developing, implementing and documenting progress of national IHR or health security plans (e.g. national action plan for health security (NAPHS), national action plan for emerging infectious diseases, public health emergencies and health security and other country level plans for health emergencies). The tool has been updated to incorporate lessons from COVID-19 and other health emergencies, to align with the updated IHR monitoring & evaluation framework (IHR MEF) tools and the health systems for health security framework, and to support strengthening health emergency prevention, preparedness, response and resilience (HEPR) capacities and the Preparedness and Resilience for Emerging Threats (PRET) initiative.
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Introduction Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to
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accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs.
Methods A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project’s Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers.
Results The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before–after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention.
Conclusion The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and cost-effectiveness of training programmes for CHWs.
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The cardiovascular disease continuum begins with risk factors such as diabetes mellitus (DM), progresses to vasculopathy and myocardial dysfunction, and finally ends with cardiovascular death. Diabetes is associated with a 2- to 4-fold increased risk for heart failure (HF). Moreover, HF patients wit
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h DM have a worse prognosis than those without DM. Diabetes can cause myocardial ischemia via micro- and macrovasculopathy and can directly exert deleterious effects on the myocardium. Hyperglycemia, hyperinsulinemia, and insulin resistance can cause alterations in vascular homeostasis. Then, reduced nitric oxide and increased reactive oxygen species levels favor inflammation leading to atherothrombotic progression and myocardial dysfunction. The classification, diagnosis, and treatment of HF for a patient with and without DM remain the same. Until now, drugs targeting neurohumoral and metabolic pathways improved mortality and morbidity in HF with reduced ejection fraction (HFrEF). Therefore, all HFrEF patients should receive guideline-directed medical therapy. By contrast, drugs modulating neurohumoral activity did not improve survival in HF with preserved ejection fraction (HFpEF) patients. Trials investigating whether sodium-glucose cotransporter-2 inhibitors are effective in HFpEF are on-going. This review will summarize the epidemiology, pathophysiology, and treatment of HF in diabetes.
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Laboratory manual for yellow fever
recommended
This WHO laboratory manual provides the most up to date methods and procedures for the laboratory identification of yellow fever virus infection in humans. It provides guidance on the establishment and maintenance of an effective laboratory providing routine surveillance testing for yellow fever, wh
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ich operates within the WHO coordinated Global Yellow Fever Laboratory Network (GYFLaN) capable of providing confirmation of yellow fever infection reliably and timely. This second edition supersedes the first edition of the 2004 WHO manual for the monitoring of yellow fever virus infection.
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Humanitarian crises exacerbate nutritional risks and often lead to an increase in acute malnutrition. Emergencies include both manmade (conflict) and natural disasters (floods, drought, cyclones, typhoons, earthquakes, volcanic eruptions, etc.). Complex emergencies are combinations of both manmade a
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nd natural disasters, often of a protracted nature. Millions of people are affected by humanitarian crises every year. The increasing frequency and scale of emergencies requires nutrition to be addressed in all phases of a response.
Crisis situations, whether acute or protracted, impact on a range of factors that can increase the risk of undernutrition, morbidity, and mortality. They may involve: the large-scale destruction of property and infrastructure; the erosion of livelihood strategies and purchasing power; a breakdown of and reduced access to essential services, including health services, water supply, and sanitation; and the displacement of large numbers of people. Emergencies can also disrupt social systems and the quality of care/feeding practices. Household access to food may be negatively affected and people may find themselves in overcrowded settlements with their families divided. As a result, at the individual level, there is often an increased risk of deteriorating health and nutritional status, resulting in a greater likelihood of death.
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Guidelines for Management of ST-Elevated Myocardial Infarction
Directorate General of Health Services
Ministry of Health & Family Welfare Government of India
(2022)
CC
Myocardial infarctions are generally clinically classified into ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI), based on changes in ECG. When blood flow to a part of the heart stops or the heart is injured and fails to receive enough oxygen required for its adequate functioning the conditi
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on is termed as STEMI or the ‘heart-attack’ in laymen language. Patients with elevated cardiac troponin levels but negative CK-MB who were formerly diagnosed with unstable angina or minor myocardial injury are now reclassified as non-ST-segment elevation Myocardial Infarction (non-STEMI) even in the absence of diagnostic changes.
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WHO has published the first-ever guidance on the clinical management of diphtheria. The only previously available guidance was an operational protocol. The new guidance followed the rigorous process for developing guidance at WHO.
It addresses the use of Diphtheria Antitoxin (DAT) in the treatmen
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t of diphtheria. There is a worldwide shortage of DAT and evidence based recommendations on the use of DAT were requested by many Member States.
The guidance also includes new recommendations on antibiotics. In patients with suspected or confirmed diphtheria, WHO recommends using macrolide antibiotics (azithromycin, erythromycin) rather than penicillin antibiotics.
This clinical practice guideline has been rapidly developed recognizing the global increase in diphtheria outbreaks. Outbreaks of diphtheria in Nigeria, Guinea and neighbouring countries in 2023 have highlighted the urgent need for evidence-based clinical practice guidelines for the treatment of diphtheria. Given the sporadic nature of outbreaks, many clinicians in the affected regions have never managed acute diphtheria and its related complications. Diphtheria remains a neglected disease and vaccination is the top priority. At the same time, for patients with diphtheria, access to antibiotics, DAT and supportive care can be lifesaving.
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The ERF provides WHO staff with essential guidance on how the Organization manages the assessment, grading and response to public health events and emergencies with health consequences, in support of Member States and affected communities. The ERF adopts an all-hazards approach and it is therefore a
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pplicable in all acute public health events and emergencies.
This version (2024) of the WHO ERF has been developed following extensive consultation across the three levels of the Organization and response experiences over the last five years of emergency response. Key areas have been updated to improve the accountability, predictability, timeliness and effectiveness of WHO’s response to emergencies.
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A sanitary inspection is a simple, on-site evaluation (traditionally using a checklist) to help identify and support the management of priority risk factors that may lead to contamination of a drinking-water supply. Sanitary inspections are a well-established and widely-applied practice. They can su
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pport water safety planning, and in some contexts, may be a simplified alternative to water safety plans.
This publication presents the World Health Organization’s (WHO’s) sanitary inspection packages. These packages update the sanitary inspection forms in WHO’s 1997 Guidelines for drinking-water quality. Volume 3: surveillance and control of community supplies. With more than 25 years of practical experience with the application of sanitary inspections, these packages have been developed from a comprehensive evidence review and established good practices.
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After introducing Ethiopia's WASH sector challenges and trends, the plan describes IRC Ethiopia's vision and strategy which draws from IRC and Water For People's joint framework - Destination 2030. It then details the organisational changes and business development needed to implement the strategic
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plan. Detailed targets are provided in the annexes.
At IRC, we believe that turning on a working tap should not be a surprise or cause for celebration. We believe in a world where water, sanitation and hygiene services are fundamental utilities that everyone is able to take for granted. For good.
We face a complex challenge. Every year, thousands of projects within and beyond the WASH sector fail – the result of short-term targets and interventions, at the cost of longterm service solutions.
This leaves around a third of the world’s poorest people without access to the most basic of human rights, and leads directly to economic, social and health problems on a global scale. IRC exists to continually challenge and shape the established practices of the WASH sector.
Through collaboration and the active application of our expertise, we work with governments, service providers and international organisations to deliver systems and services that are truly built to last.
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Objective: To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and
middle-income countries.
Methods: We systematically searched medical databases and websites of medical societies and contacted international organizations.
Co
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untry-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed
each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation).
We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of
guidelines and plans for dissemination to target audiences.
Findings: We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries.
Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending
surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development;
breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and
middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines
encompassed detailed implementation plans and socioeconomic considerations.
Conclusion: Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of
health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.
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Non-communicable diseases (NCDs) are of increasing concern for society and national governments, as well as globally due to their high mortality rate. The main risk factors of NCDs can be classified into the categories of self-management, genetic factors, environmental factors, factors of medical co
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nditions, and socio-demographic factors.
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As the Americas undergo profound demographic change and there are more persons aged 65 years or older than children younger than 5 years, it is crucial to recognize that national immunization programs must be redesigned to ensure comprehensive protection for individuals across the lifespan. By adopt
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ing a life course approach (LCA) to immunization, vaccination programs can be tailored to close immunity gaps at different stages of life. The life course approach foresees the establishment of multiple strategies to reduce missed opportunities for vaccination according to age group. This technical document explains the key concepts of the LCA with a focus on immunization by vaccination, as well as the underlying biological mechanisms that require the application different vaccines at different life stages according to changes to the immune system and in the epidemiological situation of a community.
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